• Craig D Smallwood, John N Kheir, Brian K Walsh, and Nilesh M Mehta.
• Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine craig.smallwood@childrens.harvard.edu.
• Respir Care. 2017 Apr 1; 62 (4): 475-480.

BackgroundAlthough accurate quantification of oxygen consumption (V̇O2 ) and carbon dioxide elimination (V̇CO2 ) provides important insights into a patient's nutritional and hemodynamic status, few devices exist to accurately measure these parameters in children. Therefore, we assessed the accuracy and agreement of 2 devices currently on the market using a pediatric in vitro model of gas exchange.MethodsWe utilized a Huszczuk simulation model, which simulates oxygen consumption and carbon dioxide production using gas dilution, to examine the accuracy of two FDA-cleared respiratory modules (E-COVX and E-sCAiOVX-00). V̇O2 and V̇CO2 were set at 20, 40, 60, and 100 mL/min, ranges typical for infant and pediatric patients. Bland-Altman analysis was used to calculate the bias and limits of agreement of each device relative to simulated values for V̇O2 and V̇CO2 .ResultsThe E-COVX mean percentage bias (limits of agreement) was -26.3% (-36.1 to -16.6%) and -39.3% (-47.5 to -31.1%) for V̇O2 and V̇CO2 , respectively. The mean bias (limits of agreement) for the E-aCAiOVX-00 was -0.5% (-13.3 to 12.3%) and -6.0% (-13.8 to 1.7%) for V̇O2 and V̇CO2 , respectively.ConclusionsThe E-COVX demonstrated bias and limits of agreement that were not clinically acceptable; therefore, application of this module to pediatric patients would not be recommended. The new module, E-sCAiOVX, demonstrated acceptable bias and limits of agreement for the V̇O2 and V̇CO2 in the range 40-100 mL/min (which corresponds to patients in the range of ∼5-16 kg).Copyright © 2017 by Daedalus Enterprises.

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